Endothelial cell activity varies in patients at risk for the adult respiratory distress syndrome

Abstract

The endothelial cell produces many bioactive compounds that are presumed to play important roles in the pathogenesis of the adult respiratory distress syndrome (ARDS). We postulated that individuals with sepsis and trauma--two at-risk diagnoses for the development of ARDS--might demonstrate differences in the degree of endothelial cell activity. Prospective cohort study. Intensive care unit patients in a tertiary, university-affiliated, city hospital. Fifty-five intensive care unit patients (19 with sepsis and 36 trauma patients). Plasma measurements of three endothelial cell products--von Willebrand factor antigen, soluble intercellular adhesion molecule-1 (ICAM-1), and soluble E-selectin--were performed within 8 hrs of patients meeting our inclusion criteria, and at the clinical onset of ARDS. Twenty-six percent of the septic patients and 25% of the trauma patients developed ARDS. The median (and 25% to 75% quartiles) concentrations of all three mediators measured in the sepsis patients (von Willebrand factor antigen 399% [375% to 452%], ICAM-1 573 ng/mL [470 to 980], and soluble E-selectin 180 ng/mL [81 to 340]) were significantly higher (p Conclusion These findings suggest that differences in endothelial cell activity exist between sepsis and trauma patients who are at risk for the development of ARDS.